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PROOF OF INSURANCE (2024 - 2025) CLOSEDFOSTE-2 ,a►Co CERTIFICATE OF LIABILITY INSURANCE FDATE (MMIDDmYY) 0111212024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. If IMPORTANT: he terms and conditions p policy, certain erta s p y requireINSURED provisions A st endorsed. ItMsOert f cat Idols notconfeDr h �d �ol ���s an e�DIcaONte holderAL Sn IRie Dof such elndo s ertalncy(ies) must haolicve ADDImaONLan endorsement. A statement on PRODUCER N ACT Atkinson 239�37-5555 I � T Paul G Atk� -` ce.com AX 23 826 1537 BranAtkinson UeysRdcBldg C Insurance � xt 239�37-5555n insuran.� 4 ,wl, 9 689 3..—_. atklnson tlri... .... _ . a_ ........ Fort Myers, FL 33907 1 �'�s p _ .�. , Paul G. Atkinson A009536 _ mm LL tsi ArogsxNe CovttF1 ..... deminM Com an, 25666 IN — .. .. _. ...._ _ ... —........IN V8E-",_ tI4veIers In. _ mi .... mp �! ..... f America dctuarD n u R o " ' elers Excess, 8� SL CoOster and Foster Consulting6940 ba�Fos erl�cFoster„ Inc. 50I IIyO Trav nrHarborsu SL CoC ^^^ �,,,, 29696,111. 13420 Parker Commons Blvd #104Evanston Fork Myers, FL 33912— ny 35378 Fire Insurance Compar ..... __ ...�.._. ......._. .,,,,,,,_,,Hartford rance TIFICATE IqInW CTHIS RISS TO CERTIFY THAT THE POLICIES OF INSURANCE �BLIISTED BELOW HAVE BEEN ISSUED TO THE INSURE E NAMED NUMBER. D NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS ON _ kI..,.'...-.OF . S^^UCH POLICIES. _VE BEEN REDUCED BY P1AID CLAIMS.NADDDBRPOLYPOLICY EXP EfR9S�ONAL SCpADP�V IN4URrtLIMITS PE OF INSURANCE OLICYNUMBER LACI0RENC". 1, 000,0001000 .00m_0- r- 1EXCOMMERCIAL GENERAL LIABILITY 0gR— ,, .... CLAIMS -MADE OCCURY3AA663648 04/17/2023 04/17/20241AMAGE NORwNTED 100 000 .5,000 D XCY3wR LIABILITY' CY610790987800 01/01/2024'01/01/2025S1. .- Excluded ...... 00,000 GEN L AGGREGATE LIMIT APPLIES PER. EX PRO-1:1 U _PA9 ..._P X_], POLICY' LOC wL „00 CYBEA 07HER^ YR RRETIJ0,000 �B COIvtBpNE# IMftRT 1,000,000 �®...n.._ . A AUTOMOBILE LIABILITY i .D SINGLE . P GF�,T�ZI�a�+dY X ANY AUTO ...... BA-9T746362-24-+32-G 101/01/2024 01101/2025� BocilmrmltaJiRYA OWNED SCHEDULEED AUTOS ONLY AUTOSOPRdE AMAOE EcidenC".."" X HfNFO X NONi'WYM#"'D .... _.._ $.. ..�.....- H S ONLY y....— N'ON-OWNED ONED BODItl Y INJ iit'Y Rey tt.m� ...... NL I EACffl_!OCCU/3RENn"r _ E UMBRELLA LIAB X OCCUR„� E EZS3"I13511 04/17/2023 04/17/2024 _ 5 000 000 WORKERS COLD RETENTION $"CLAIMS MAD X EXCESSAGGR_E_GAM A COMPENSATION Y 1 X SL��AE6 01H. ..._ �1,000'... AND EMPLOYERS'LIABILITY N UB-8J390686-24-42-E 01/01/2024 01/01/2025 0 ANY PROPRIEr'OF VPAR'TNEWE'X'�ECUTIVE X f Y w F L EAw.,H.AGCIOi�N'r S,._ DI` IECERBMafiEMBER EXCLUDED? �...,...k NIA NO DEDUCTIBLE .�_.. 1,000,000 .. (Malydatory In NH) if yes, deg0be under E L- DISEA wE • PO[ OY LiIMu� 1000„000 1 IDE,S `RIPTON OF PER'.ATWI NS below , C PROF LIAB E O MPP 9037522 05 $2.50K DIED 01/01/2024 0110I12025 PL-EA CLM 5,000,000 F BOND $500,000 2r1BDDJA6409 04/17/2023 04/17/2024 PL-AGGREG 5,000',000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City! of EI Segundo, its officials and employees are listed as additional Insureds With resppects to the eneral liability per Written contract. General Liability Coverage is Primary. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of El Segundo 350 Main Street El Segundo, CA 90245 AUTHORIZED REPRESENTATIVE 0LJ ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM LIQUOR LIABILITY COVERAGE FORM OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM SCHEDULE Additional Premium- $629 (Check box if fully earned ❑) Please refer to each Coverage Form to determine which terms are defined. Words shown in quotations on this endorsement may or may not be defined in all Coverage Forms. A. Who Is An Insured is amended to include as an additional insured any person or entity to whom you are required by valid written contract or agreement to provide such coverage,, but only with respect to "bodily injury", "property damage'" (including "bodily injury" and "property damage" included in the "products -completed operations hazard"), and "personal and advertising injury"" caused, in whole or in part, by the negligent acts or omissions of the Named Insured and only with respect to any coverage not otherwise excluded in the policy. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. The insurance afforded to such additional insured will not be broader than that which you are required by the valid written contract or agreement to provide for such additional insured. Our agreement to accept an additional insured provision in a valid written contract or agreement is not an acceptance of any other provisions of such contract or agreement or the contract or agreement in total. When coverage does not apply for the Named Insured, no coverage or defense will apply for the additional insured. No coverage applies to such additional insured for injury or damage of any type to any "employee" of the Named Insured or to any obligation of the additional insured to indemnify another because of damages arising out of such injury or damage. B. With respect to the insurance afforded to these additional insured, the following is added to limits of insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the valid written contract or agreement; or 2. Available under the applicable limits of insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable limits of insurance shown in the Declarations. All other terms and conditions remain unchanged. MEGL 0009-01 09 18 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. Policy #: 3AA663648 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a. Named Insured under such other insurance, and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG 20 01 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 � WORKERS COMPENSATION TRAVEL�,M AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 99 03 76 ( A) - 001 POLICY NUMBER: UB-8J390688-24-42-E WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. The additional premium for this endorsement shall be 2.00 % of the California workers' compensation pre- mium. Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR ACTUARIAL CONSULTANTS WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No.. Insured Premium Insurance Company Countersigned by DATE OF ISSUE: 12-05-23 ST ASSIGN: Page 1 of 1